Thursday, 8 May 1986
Dáil Eireann Debate
An Ceann Comhairle: Deputy Hugh Conaghan has been given permission to raise on the Adjournment: “The lack of funding from the Department of Health to the North Western Health Board which has caused the withdrawal of transport services to extern clinics in Dublin and clinics in Donegal with resulting hardship on the poor of the region.” The Deputy has 20 minutes.
Mr. Conaghan: First, I want to thank you, Sir, for having allowed me the time to discuss this important matter on the Adjournment. It is unfortunate that the Minister for Health is not present to listen to the case I propose to make in relation to the cutbacks that have taken place in the North Western Health Board area.
The North Western Health Board have always taken a very responsible approach to their deliberations in relation to the adoption of the Estimates, have always given full recognition to the economic difficulties of the country. The board have now come to the point that they are unable to absorb the massive cutbacks of £3.2 million in the 1986 Estimates or run the services within the region without effecting a very drastic rundown in those services and lay-off of staff. Since 1980 cutbacks in the Department funding have amounted to 20 per cent. During the period 1980 to 1986 the board received special additional allocations for a small number of approved developments, namely, the extension of Letterkenny General Hospital, the orthopaedic unit at Sligo General Hospital, the community nursing units in County Donegal and a unit for mentally handicapped at Stranorlar in 1986. The cost of these services amounted to £6.4 million. Therefore, in 1986 terms the total value of the 1980 level of resources, together with the adjustments made by the Department since then for approved services, is £79.7 million, which is 20 per cent greater than the 1986 allocation. It could be said that  we had 20 per cent more resources for the services we provided in 1980 than is being provided this year, which is a clear indication of the cuts effected in that period. Despite these cuts a number of significant changes have been made in that period by way of internal transfers between the service budgets, thus allowing for the establishment of a number of new services.
When the Minister met a deputation from the board on 28 February 1986 he indicated that the case made to him, and the points contained in the documentation supplied, would be fully considered and that another meeting would take place within two or three weeks. The Minister also asked the board to defer consideration of the major service changes which would arise from the cuts implied in his letter of allocation of 29 January 1986.
We welcome the presence of the Minister here. It is clear that he is fully aware of the consequences of the £3.2 million cutback. He received a full report from the CEO of the health board and knows the consequences for that board.
I am concerned about the effects which the cutback will have on the underprivileged in the north-west region. Community care services have been cut by £700,000, which equals 3 per cent of the total budget. The cost of transport services to hospitals, clinics and the like is £615,000 made up as follows: day hospitals, £110,000; workshops, £90,000; external clinics, including Dublin, Galway and other hospitals, £85,000; internal clinics £330,000. Transport to the day hospitals and workshops will be continued and also for people attending the renal-dialysis unit, but all other transport services will be discontinued. This is where the crunch comes and where the hardship takes place.
I am not pleading a special case for the North Western Health Board, or that we should get special treatment. I am saying we are not getting the recognition we should be getting. I wish to put on record that the area which the board serves has special features which do not appertain to the areas of other boards. First, this  is mostly a rural region; secondly, the majority of the people live long distances from the services; thirdly, 85 per cent of the population live outside towns; fourthly, the average income per family is the lowest in the country; fifthly, we have the highest population over 65 years of age of the entire country, which in itself normally implies a greater demand for hospital services; sixthly, the region also has 3.78 hospital beds per 1,000 of population, which is the lowest in the country.
These circumstances put a severe drain on scarce resources. If we were to make comparisons, we could compare a person living in North Inishowen with a person living in Ballymun in Dublin, needing to attend a hospital clinic. The distance in the Donegal case is 40 miles each way, imposing a cost of about £30 for a taxi, compared with a bus fare of 70p each way in Dublin. If we were to go to the other extreme and consider a Donegal person who has to attend a hospital in Dublin, we would be talking of a figure in excess of £100, by comparison with the 70p Dublin bus fare. These are the economic factors.
When one comes to the human aspect and takes into consideration a sick person having to make all the arrangements in relation to a journey of almost 200 miles each way, an overnight stay in the city and transport to and from the hospital, surely this is clear evidence that no consideration has been given by the Minister's Department to the consequences of the cutbacks and the effects on human beings whom the Minister and I and everybody else desire to serve. Public transport in the north west region is virtually non-existent.
I am putting it to the Minister tonight that there is no way in which the North Western Health Board can operate or maintain services within the present allocation. I believe in all sincerity that the Minister recognises that fact. We acknowledge that he allocated an extra £310,000 for the very important renal-dialysis units in Letterkenny and Sligo and for the running of the Buncrana community  welfare home. I appeal to him to take into consideration the arguments which I am putting to him and to provide extra funding to alleviate the hardships now being imposed on the people in that region.
The people about whom I am talking here have a disabled person's maintenance allowance of about £36 to £40 a week. How can we expect those who are sick to arrange transport and get to a clinic in Letterkenny or Sligo hospital, or to a clinic in Dublin, and provide the money needed for those journeys? It is clearly impossible. Many of such people will forego attending the clinics and eventually will wind up in an acute hospital. The responsibility must fall on the Minister's shoulders as the man responsible for providing the money for these services and as the only person who can redeem those people from this ridiculous situation.
I want to put on record that the CEO and officers of the North Western Health Board are stretched to the pin of their collar to maintain the operation of the services within the north western region. The Minister will be forced to admit that the North Western Health Board, of which I had the privilege to be chairman last year, have never come to the Minister with a case which was not valid. I am pleading the case for that region against the cutbacks which we have had to accept in the Estimate. This is only one aspect of the effects but it is a very serious one. We are hitting at the most under-privileged people within the community, a community which has the highest rural population, the least number of acute hospitals, with distances of from 40 to 100 miles involved.
There is no way in which the Minister or his Department can justify an allocation to the north western region which was equated with the needs of the boards in other parts of the country. I am speaking here specifically in relation to the Eastern Health Board and Dublin. We have not the same facilities. We are a remote region, virtually out on a limb.  No argument can sustain the cutback of £3.2 million. I am asking the Minister seriously to consider the plight of the health board officials and the staff who are responsible to the Minister in the community.
It is fair to say we have kept in line with the policy thinking of the Minister's Department and of the thinking of the previous Government in relation to the Department of Health as regards developing the community services. We have developed the services and the board now find that they have not the funding to maintain them. The consequences of the shortfall would be a justifiable argument for the Minister to go to the Government and ask for the extra funding for the North Western Health Board. We acknowledge the extra £310,000 given, but that does not overcome the difficulties in which the board find themselves and that the unfortunate people depending on their services are asked to bear.
In view of the very constructive and successful meeting that the chairman, Deputy Harte, the CEO of the North Western Health Board and I had with the Minister, I hope he will give full recognition to the very detailed document which the CEO presented to him in relation to the situation in which he finds himself. I conclude with a final appeal to the Minister to have a hard look at the difficulties in which the under-privileged people now find themselves and the difficulties in which his staff find themselves in trying to maintain and run a health service in the most difficult region of the eight health boards.
Mr. M. Brennan: I did not intend to speak on this subject, but I support Deputy Conaghan. As he said, the whole area is a very rural, remote one and is deprived. We are far removed from the urban areas. The Minister must treat our appeal sympathetically and ensure that transport is laid on for our senior citizens. In the past the service may have been abused but there are a number of elderly people who have no means of transportation. They have to hire a taxi, and to hire  a taxi from Bellaghy and Charlestown to Sligo would cost £16 to £17. That would amount to about half of an old age pensioner's weekly income.
I am appealing to the Minister, the same as Deputy Conaghan has done already, to make sure that our old age pensioners who have no way of getting to clinics have free transport, particularly those who are asked to travel to Dublin. For goodness sake, how are they supposed to get there unless there is an ambulance service? That ambulance service should be continued in order to bring these people to our capital city. In our area we have not buses on every route as they have in Dublin. If we had, it would be easy for people who have free transport to get to hospitals and clinics. In supporting Deputy Conaghan I hope that the Minister will see fit to give old age pensioners who have no means of transportation whatsoever free transport to hospitals and clinics in Dublin, or wherever else they have to go.
The North Western Health Board's overall allocation for 1986, including their share of the expenses of the General Medical Services Payment Board and to the cost of voluntary hospitals and homes, is £84.441 million. This compares with a figure of £80.282 million at budget stage last year, which is the comparable figure to be taken. Basically, this is an increase of slightly over 5 per cent. I would argue that, with the inflation rate down to 2½ per cent, for health board expenditure it is probably another 1 per cent higher because of the change in foodstuffs and so on. There are compensatory changes against that 5 per cent. For example, the cost of energy in health boards is substantially down. The overall increase to £84.441 million as against £80.282 million at this time last year is up by a reasonable proportion of £4.159 million. If one takes the direct expenditure of the board, this year the allocation is £66.48 million as against £63.31 million  at budget time last year. Again, this is up by around 5 per cent. I do appreciate that this is a very tight figure, but everyone has been used to getting 10 per cent or 12 per cent and at one stage 15 per cent increases. I am not saying that they necessarily applied to the North Western Health Board.
In a situation where the budgets have been tight, all of the health boards have been examining the services they deliver to the population at large. I met a deputation from the North Western Health Board on 28 February. In regard to the problems which Deputies generously indicated, I agreed that we would make additional moneys of about £310,000 available for the continuance of the renal dialysis services, which are absolutely essential, and for the Buncrana Community Nursing Unit. I will also be able to provide some limited funds to finance the community psychiatric services, which are very good in the area. These have been turned around into the model we are all endeavouring to introduce. That, in effect, is a limit on the situation and we boil it down now to the transport.
I would point out that the ordinary transport arrangements for the North Western Health Board will continue to be provided directly to the day hospitals. That is as it should be. It will be provided to the renal dialysis service units. It will continue to be provided to the mental handicap units and from one hospital to another. There will also be certain cases where special arrangements will be made. A register of those cases is being drawn up by the health board. In addition, special concession travel has been made available by the public transport authorities in the area on presentation of authorised clinical appointments.
There is a discontinuance of the automatic entitlement to transport services to clinics or to X-rays, but where there is any kind of genuine hardship involved there is a refund of reasonable transport expenses incurred. I presume this will include a taxi requirement on a pre-authorised basis. I want to assure Deputies that any person in genuine need  should not and will not suffer undue financial hardship arising out of these measures. I want to make it absolutely clear that there is no reduction in the ambulance service, which is essentially an emergency service but which is used fairly widespread within the area for a variety of other purposes. That is not being withdrawn.
Therefore, certain automatic taxi facilities are being curtailed. Knowing the officers of the health boards, that can be done and shall be done in a sensitive and reasonable way. I want to thank the Deputies for the fact that when I received the deputation we had a constructive and very responsible attitude shown by the health board and their CEO when we got down to discussing their budget for 1986. It was an extremely effective and reasonable exchange of views. I will keep the budget of the North Western Health Board under monthly review in the Department. If I have any additional funds available throughout the year, I will bear in mind the representations of the Deputies here this evening. I will not be in any way stinting on them should any additional moneys come through either on appropriations-in-aid or any other aspects of additional funding which might arise for one reason or another within the overall framework of the revenue allocation to me for 1986.
These are the main observations I would like to make. My job is to deliver the services at the least possible cost. The high cost of transport is one of the major studies undertaken by the Department. These studies have been circulated to the health boards. Therefore if the boards take some of the aspects of our reports on tow in relation to their budgets, I cannot in any way criticise them. I want to assure my parliamentary colleagues that that is all I have by way of non-capital health expenditure for the health board. I must remain within my budget framework.
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